Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: There are established and validated clinical decision tools for cervical spineclearance. Almost all the rules include spinal tenderness on exam as an indication for imaging. Ourgoal was to apply GLASS, a previously derived clinical decision tool for cervical spine clearance, tothoracolumbar injuries. GLass intact Assures Safe Spine (GLASS) is a simple, objective method toevaluate those patients involved in motor vehicle collisions and determine which are at low risk forthoracolumbar injuries.

Methods: We performed a retrospective cohort study using the National Accident Sampling System-Crashworthiness Data System (NASS-CDS) over an 11-year period (1998-2008). Sampled occupantcases selected in this study included patients age 16-60 who were belt-restrained, front- seatoccupants involved in a crash with no airbag deployment, and no glass damage prior to the crash.

Results: We evaluated 14,191 occupants involved in motor vehicle collisions in this analysis.GLASS had a sensitivity of 94.4% (95% CI [86.3-98.4%]), specificity of 54.1% (95% CI [53.2-54.9%]), and negative predictive value of 99.9% (95% CI [99.8-99.9%]) for thoracic injuries, and asensitivity of 90.3% (95% CI [82.8-95.2%]), specificity of 54.2% (95% CI [53.3-54.9%]), and negativepredictive value of 99.9% (95% CI [99.7-99.9%]) for lumbar injuries.

Conclusion: The GLASS rule represents the possibility of a novel, more-objective thoracolumbarspine clearance tool. Prospective evaluation would be required to further evaluate the validity of thisclinical decision rule.